Healthcare Provider Details

I. General information

NPI: 1760444152
Provider Name (Legal Business Name): ROBERT DIBIANCO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15215 SHADY GROVE RD SUITE 306
ROCKVILLE MD
20850-3235
US

IV. Provider business mailing address

15225 SHADY GROVE RD STE 201
ROCKVILLE MD
20850-3278
US

V. Phone/Fax

Practice location:
  • Phone: 301-990-0040
  • Fax: 301-990-0043
Mailing address:
  • Phone: 301-670-3000
  • Fax: 301-924-0186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0022846
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: